The Nottingham Study of Neurotic Disorder: relationship between personality status and symptoms

1990 ◽  
Vol 20 (2) ◽  
pp. 423-431 ◽  
Author(s):  
P. Tyrer ◽  
N. Seivewright ◽  
B. Ferguson ◽  
S. Murphy ◽  
C. Darling ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Personality Assessment ◽  
Psychiatric Patients ◽  
Structured Interview ◽  
Dysthymic Disorder ◽  
Behaviour Therapy ◽  
Personality Assessments ◽  
Neurotic Disorder ◽  
Severe Psychopathology ◽  
Apparent Influence

SynopsisTwo hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

The Nottingham Study of Neurotic Disorder

1993 ◽  
Vol 162 (2) ◽  
pp. 219-226 ◽  
Author(s):  
Peter Tyrer ◽  
Nicholas Seivewright ◽  
Brian Ferguson ◽  
Siobhan Murphy ◽  
A. L. Johnson
Keyword(s):  
Personality Disorder ◽  
Drug Treatment ◽  
Psychological Treatment ◽  
Compliance Rate ◽  
Dysthymic Disorder ◽  
Behaviour Therapy ◽  
Interview Schedule ◽  
Neurotic Disorder ◽  
Self Help ◽  
Selection Of

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM–III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Prediction of outcome in neurotic disorder: a 5-year prospective study

1998 ◽  
Vol 28 (5) ◽  
pp. 1149-1157 ◽  
Author(s):  
H. SEIVEWRIGHT ◽  
P. TYRER ◽  
T. JOHNSON
Keyword(s):  
Initial Response ◽  
Favourable Outcome ◽  
Dysthymic Disorder ◽  
Response To Treatment ◽  
Behaviour Therapy ◽  
Neurotic Disorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Predicting Outcome

Background. There have been no previous studies of the outcome of different neurotic disorders in which a prospective group with original randomization to treatment have been followed up over a long period. Such studies are important in identifying the factors associated with good and poor outcome.Methods. A 5-year follow-up assessment was made of a cohort of 210 psychiatric out-patients seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74) or dysthymic disorder (65) and randomized to drug treatment, cognitive and behaviour therapy, and self-help. A total of 182 of the patients (87%) were assessed after 5 years by examination of hospital and GP records using a standardized procedure and outcome determined with a four-point outcome scale.Results. One hundred and seven (60%) of the patients had a favourable outcome but the remainder continued to be handicapped either intermittently or continuously throughout the 5-year period. Analysis of the value of initial data in predicting outcome using polychotomous step-wise logistic regression revealed that five variables were significant predictors of poor prognosis: older age; recurrent episodes; the presence of personality disorder at entry; general neurotic syndrome at entry; and symptom severity after 10 weeks. The initial DSM diagnosis and original treatment given, together with ten other variables, were of no predictive value.Conclusions. The long-term outcome of neurotic disorder is better predicted by age, personality and recency of onset than by other clinical variables with the exception of initial response to treatment.

How to choose the best screening instrument for personality disorder for your specific practice

2011 ◽  
Vol 26 (S2) ◽  
pp. 1019-1019
Author(s):  
S. Germans ◽  
G.L. Van Heck ◽  
P.P.G. Hodiamont
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Personality Assessment ◽  
Structured Interview ◽  
Screening Instrument ◽  
Mental Illnesses ◽  
Standardized Assessment ◽  
Short Version ◽  
Specific Practice ◽  
Neo Five Factor Inventory

IntroductionPersonality disorders (PD) are common in psychiatric services and can adversely affect the management and outcome of mental illnesses. Therefore assessment of the personality is an essential part of initial psychiatric examination. To diagnose a PD takes time and competence. A screening instrument in the diagnostic phase can be a solution.AimThe goal of the study was to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.MethodNine screening instruments were studied in a prospective, observational, test development study with a random sample of Dutch psychiatric outpatients, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality- Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II), three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF)) involved.ResultsThe three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.ConclusionBefore deciding which screening instrument for PD is the best for your practice, you have to consider psychometric values as well as practical circumstances.

The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder

2004 ◽  
Vol 34 (8) ◽  
pp. 1385-1394 ◽  
Author(s):  
PETER TYRER ◽  
HELEN SEIVEWRIGHT ◽  
TONY JOHNSON
Keyword(s):  
Anxiety Disorder ◽  
Personality Disorder ◽  
Generalized Anxiety Disorder ◽  
Depressive Disorders ◽  
Favourable Outcome ◽  
Dysthymic Disorder ◽  
Generalized Anxiety ◽  
Neurotic Disorder ◽  
Term Outcome ◽  
Long Term Outcome

Background. Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors.Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.

Adolf Hitler: a re-assessment of his personality status

1993 ◽  
Vol 10 (3) ◽  
pp. 148-151
Author(s):  
Desmond Henry ◽  
Dick Geary ◽  
Peter Tyrer
Keyword(s):  
Personality Disorder ◽  
Personality Assessment ◽  
Third Reich ◽  
Structured Interview ◽  
Adolf Hitler ◽  
Historical Figures ◽  
Icd 10 ◽  
Special Knowledge ◽  
The Third Reich ◽  
Personality Disturbance

AbstractObjective: The assessment of the personality status of Adolf Hitler using a structured interview schedule, the Personality Assessment Schedule, with two informants, one a psychiatrist with an interest in psychohistory and the other a historian with special knowledge of the Third Reich and Weimar Republic. Method: The Personality Assessment Schedule was given in two forms to the two informants at different times; on each occasion Hitler was assessed as he was in 1937. Results: There was considerable discrepancy between the ratings of the two informants, the historian recording less-personality disturbance in all areas of function, although correlations between the two sets of ratings were relatively high (R1 0.5-0.6), with rater bias accounting for the differences in severity. Both informants regarded Hitler as having a dissocial personality disorder (using the new ICD-10 criteria), but the psychiatrist's rating also scored the diagnosis of paranoid and histrionic personality disorders. Conclusions: Interview schedules which use informants to assess personality disorder can be of value in examining the personality status of historical figures.

DSM‐IV personality disorders and the Five‐Factor Model of personality: a multi‐method examination of domain‐ and facet‐level predictions

2005 ◽  
Vol 19 (4) ◽  
pp. 307-324 ◽  
Author(s):  
R. Michael Bagby ◽  
Paul T. Costa ◽  
Thomas A. Widiger ◽  
Andrew G. Ryder ◽  
Margarita Marshall
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Factor Model ◽  
Psychiatric Patients ◽  
Five Factor Model ◽  
Structured Interview ◽  
Self Report ◽  
Neo Personality Inventory ◽  
Personality Functioning ◽  
Personality Psychopathology

The personality disorder classification system (Axis II) in the various versions of the Diagnostic and Statistical Manuals of Mental Disorders (DSM) has been the target of repeated criticism, with conceptual analysis and empirical evidence documenting its flaws. In response, many have proposed alternative approaches for the assessment of personality psychopathology, including the application of the Five‐Factor Model of personality (FFM). Many remain sceptical, however, as to whether domain and facet traits from a model of general personality functioning can be successfully applied to clinical patients with personality disorders (PDs). In this study, with a sample of psychiatric patients (n = 115), personality disorder symptoms corresponding to each of the 10 PDs were successfully predicted by the facet and domain traits of the FFM, as measured by a semi‐structured interview, the Structured Interview for the Five Factor Model (SIFFM; Trull & Widiger, 1997) and a self‐report questionnaire, the Revised NEO Personality Inventory (NEO PI‐R; Costa and McCrae, 1992). These results provide support for the perspective that personality psychopathology can be captured by general personality dimensions. The FFM has the potential to provide a valid and scientifically sound framework from which to assess personality psychopathology, in a way that covers most of the domains conceptualized in DSM while transcending the limitations of the current categorical approach to these disorders. Copyright © 2005 John Wiley & Sons, Ltd.

Temporal reliability of personality in psychiatric patients

1983 ◽  
Vol 13 (2) ◽  
pp. 393-398 ◽  
Author(s):  
P. Tyrer ◽  
J. Strauss ◽  
D. Cicchetti
Keyword(s):  
Personality Disorder ◽  
Personality Traits ◽  
Personality Assessment ◽  
Clinical Symptoms ◽  
Psychiatric Patients ◽  
Chronic Patients ◽  
Interview Schedule ◽  
Individual Personality ◽  
Categorical Diagnosis ◽  
Severe Personality Disorder

SYNOPSISThe Personality Assessment Schedule, an interview schedule specifically designed for assessing personality disorder, was administered twice to 28 psychiatric patients, with a mean interval of 2·9 years between each assessment. The first assessment was made by a psychiatrist and the second by a medical student who had no prior knowledge of the patients. The reliability of the 2 assessments was measured using 4 different techniques. Although the reliability of individual personality traits was inconsistent over time, the categorical diagnosis of personality disorder was good (Kωw = 0·64), giving some support to the validity of the schedule. Reasons for discordance in the assessments were examined and appeared to be due mainly to confusion between clinical symptoms and personality traits, retrospective errors in recording past personality in chronic patients, and special difficulties in determining the primary abnormality in severe personality disorder.

scholarly journals Personality change in the Nottingham Study of Neurotic Disorder: 30-Year cohort study

2021 ◽  
pp. 000486742110256
Author(s):  
Min Yang ◽  
Helen Tyrer ◽  
Tony Johnson ◽  
Peter Tyrer
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Assessment ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
Controlled Trial ◽  
Stable Condition ◽  
Personality Change ◽  
Neurotic Disorder ◽  
Cluster A

Background: Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years. Methods: Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline. Results: Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197). Conclusion: In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.

Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome

2017 ◽  
Vol 33 (3) ◽  
pp. 158-165
Author(s):  
Natalia Calvo ◽  
Naia Sáez-Francàs ◽  
Sergi Valero ◽  
Jesús Castro-Marrero ◽  
José Alegre Martín ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Chronic Fatigue Syndrome ◽  
Personality Assessment ◽  
Chronic Fatigue ◽  
Specific Pattern ◽  
Harm Avoidance ◽  
Assessment Instrument ◽  
Compulsive Disorder ◽  
Fatigue Syndrome ◽  
Self Transcendence

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.

scholarly journals Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study

2021 ◽  
pp. 025371762199953
Author(s):  
Bhavneesh Saini ◽  
Pir Dutt Bansal ◽  
Mamta Bahetra ◽  
Arvind Sharma ◽  
Priyanka Bansal ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychiatric Disorders ◽  
Psychotic Disorders ◽  
Age Of Onset ◽  
Psychiatric Patients ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Sectional Study ◽  
Cross Sectional ◽  
Neurotic Disorders

Background: Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. Methods: This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18–45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. Results: Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. Conclusions: PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.

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